Left shoulder arthroscopy and subacromial decompression and manipulation under anesthesia.

PROCEDURE:  Left shoulder arthroscopy and subacromial decompression and manipulation under anesthesia.

PREOPERATIVE DIAGNOSIS:  Left shoulder bursitis and tendonitis.

POSTOPERATIVE DIAGNOSIS:  Left shoulder bursitis and tendonitis plus adhesive capsulitis

FINDINGS:  Capsulitis of the shoulder with stiffness and scar formation, positive bursitis and a large subacromial spur intact, rotator cuff, no labral tears, and no biceps tendons.

SPECIMENS:  None.

COMPLICATIONS:  None.

ANESTHESIA:  General endotracheal anesthesia by David Ritter, MD

ESTIMATED BLOOD LOSS:  Minimal.

INDICATIONS:  The patient is a 49-year-old female with a long history of left shoulder pain, soreness, difficulty with overhead activities, indications for surgical intervention after failure of conservative efforts.  Risks and benefits have been discussed prior to the procedure and all questions were answered.

PROCEDURE IN DETAIL:  She was brought to the operating room after adequate anesthesia had been obtained placed in a beach-chair position, prepped and draped in the usual sterile fashion.  Evaluation of the shoulder revealed marked capsulitis, as we brought her up she was only able to passively go to about 45 degrees then was able to break up adhesions, abduct throughout to 90 to 95 degrees, and externally rotate fully with audible breaking of adhesions.  There was no crepitus I suppose.  At this point, we established a posterior portal with a spinal needle.  In standard fashion, made a stab wound and introduced the scope into the shoulder joint.  At this point, we distended the shoulder joint; there was some hyperemia from the capsulitis in the manipulation but otherwise intact biceps tendon, intact labrum, minimal degenerative changes.  Intact rotator cuff tendon insertion onto the humerus.  At this point, we moved the scope into the subacromial spaced and established lateral portal.  The initial lateral portal was slightly high, so we made a second lateral portal slightly inferior.  At this point, we had a good overall positioning and at this time we were able to remove a large amount of bursal tissue with the use of a 4-0 full-radius shaver.  We then placed the ablator into the subacromial space and ablated the underside of the periosteum of the acromion and then took the CA ligament.  At this point, a large subacromial spur was noted, placed the 5-5 acromionizer in place and performed a standard 8-10 mm acromioplasty, good overall space provided.  No evidence of further rotator cuff tendon tear.  We then copiously irrigated suction dried the shoulder and subacromial space.  We then removed all instruments, closed with a combination of simple interrupted sutures.  Infiltrated the wounds and the intra-articular as well as subacromial space with 30 mL of 0.5% Marcaine without epinephrine and then dressed with Adaptic sterile gauze dressing ABD, Medipore tape followed by polar cuff and a sling _____.  The patient was awoken in the operating room brought stable to Post Anesthetic Care Unit in good condition.